Sleeve Gastrectomy Tied to Lower Fracture Risk in Patients With Severe Obesity

By Lisa Rappaport

July 13, 2020

(Reuters Health) - People with severe obesity who undergo sleeve gastrectomy may be less likely to experience fractures than individuals who get Roux-en-Y procedures or those who are eligible for bariatric surgery and don't get it, a recent study suggests.

Researchers examined Medicare data on 49,113 people with severe obesity who were eligible for bariatric surgery from 2004 to 2014. The analysis included three groups of patients in roughly equal numbers: those who didn't have weight loss surgery, those who underwent sleeve gastrectomy (SG), and those who had Roux-en-Y gastric bypass (RYGB).

Overall, a total of 1,382 patients (2.8%) experienced fractures during the study. Fracture rates were similar for people who didn't get surgery (3.4%) and those who had RYGB procedures (3.2%), but significantly lower with SG procedures (1.8%).

"The generally accepted notion that obesity is protective when considering the risks of fracture may not be as straightforward as previously thought," said senior study author Dr. Alfonso Torquati of Rush University in Chicago.

"The benefit of sustained and significant weight loss can lead to less risk of fall-related injuries that are the ultimate cause for bone fracture," Dr. Torquati said by email.

To assess the connection between bariatric surgery and fractures, researchers focused on the odds of fractures based on surgery exposure over three years. As a secondary endpoint, they also examined site-specific fractures at the humerus, ulna or radius, pelvis, hip, and vertebrae.

Each of the three groups in the study were similar in baseline characteristics, including the proportion with hypertension (71.8%), smoking (30.8%), NAFLD (0.7%), hyperlipidemia (56.8%), osteoporosis (3.8%), osteoarthritis (26.2%), obstructive sleep apnea (45.2%), and type 2 diabetes (47.6%).

There were no significant differences in the odds of fracture overall or at specific sites between people eligible for surgery who didn't have it and those who underwent RYGB procedures, researchers report in JAMA Network Open.

However, individuals who underwent SG procedure had lower odds of fractures overall (odds ratio 0.53) than those eligible for bariatric surgery who didn't get it. In addition, people who had SG procedures had lower odds of fractures at the humerus (OR 0.57), radius or ulna (OR 0.38), pelvis (OR 0.34), hip (OR 0.60), and vertebrae (OR 0.60).

One of the study's limitations is that it is retrospective, looking back at available data, noted Dr. Cynthia Brown of the University of Alabama at Birmingham. "While patients were matched on a number of factors, it is possible that other factors play a role in the development of fractures and that these factors were not accounted for. For example, having balance or walking problems may lead to a high rate of falls and subsequent fractures, but these data were not available to be studied. Other details such as the amount of weight lost or the severity of disease is not captured using these types of datasets, which are designed for financial and administrative use, not for research."

Even so, the results should encourage clinicians to consider gastric bypass for their patients who need the procedure, with less fear of there being an increased risk of fractures, said Dr. Brown, who wasn't involved in the study.

"Clinicians may at least consider use of the gastric sleeve over the Roux-en-Y gastric bypass procedure if fracture risk is a concern," she said by email. "However, more studies will need to be done given the limitations noted above."

SOURCE: JAMA Network Open, online June 10, 2020.